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HYPERLINK "" Nursing CHEST PHYSIOTHERAPYIs an airway clearance technique that combines :1 ) Positioning or postural drainage (allowing gravity to help drain secretions into central airways ) .2 ) Rhythmic percussion of the chest wall (to help loosen secretions) .3 ) Vibration 4 ) Coughing and breathing . These procedure done :-? Before morning meal .-? At bed time (if the child is subject to? nighttime mucous retention , plugging of? airways , and coughing) .-? If infection is present .-? Bronchodilator is administered by nebulizer .Preparation :1) Ensure that several hours have passed since the child has eaten .2) Perform a baseline respiratory assessment. Place the child on a pulse oximeter .3) Place the child in the position to permit gravity drainage of secretion .4) Administer the bronchodilator , if ordered , to relax the airway muscles .EQUIPMENT:1) Oxygen mask , baby bottle nipple (for infant) .2 ) Emesis basin or sputum cup .3 ) Pulse oximeter .4 ) TissuesDuring postural drainage , 2 maneuvers can be done to aid drainage :1) Percussion :Produces chestvibrations that dislodge retainedsecretions .1) If using the hands to percuss the chest , hold the hands cupped with fingers and thumb together . Keep the wrists loose , elbows partially flexed , and strike the chest alternating the hands . Listen for a hollow sound . 2 ) Develop a rhythm with the alternate hands and cover the targeted chest area in a circular pattern for 3 - 5 minutes .3 ) Avoid tender area , the breasts of an adolescent girl , and bony prominences such as clavicles or vertebrae .Rationale : Percussion focused over intercostal spaces to? loosening secretions.4 ) Have the child change position to drain another area of the lungs and percuss that area for 3 – 5 minutes , continue this process until all areas of the chest have been percussed.5 ) The positions used for each patient are based on the location of mucous obstruction.6) Encourage the child to take a few deep breaths and cough after percussion in each location. Have the child expectoratesputum into an emesis basin or cup .Rationale : The deep breaths increase the velocity of expired air & help to move the secretions toward the trachea where they can be coughed up .7 ) Monitor the child’s cardiorespiratory status .2 ) Vibration :Is application of downward vibrating pressure with the flat part of the palm over the area that is being drained . Procedure :1) Position one hand flat on the chest over the involved area and the other hand on top of the first . Alternately , the hands may be placed side by side on the chest . Keep the arms and shoulders straight .2 ) Tell the child to take deep breath , inhaling through the nose and exhaling through the mouth .Vibration : is performed only during? exhalation3 ) Vibrate the area by tensing and relaxing your arms for 10 – 15 seconds .Perform these tensing and relaxing actions for 3 – 5 minutes . Move to another area of the chest and repeat the process . 4 ) Encourage coughing between vibration and expectoration of sputum into a cup or emesis basin . ................
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